Colloid solutions for fluid resuscitation

Colloid solutions for fluid resuscitation (Review)Bunn F, Trivedi D
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library2012, Issue 11
Colloid solutions for fluid resuscitation (Review)Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.[Intervention Review]Colloid solutions for fluid resuscitation
1Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
Contact address: Frances Bunn, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane,Hatfield, Hertfordshire, AL10 9AB, UK. .Editorial group: Cochrane Injuries Group.Publication status and date: Edited (no change to conclusions), published in Issue 11, 2012.Review content assessed as up-to-date: 1 December 2011.Citation: Bunn F, Trivedi D. Colloid solutions for fluid resuscitation. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.:CD001319. DOI: 10.1002/14651858.CD001319.pub5.
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.A B S T R A C TBackground
Colloids are widely used in the replacement of fluid volume. However, doubts remain as to which colloid is best. Different colloidsvary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this, and their othercharacteristics, they may differ in their safety and efficacy.Objectives
To compare the effects of different colloid solutions in patients thought to need volume replacement.Search methods
We searched the Cochrane Injuries Specialised Register (searched 1 December 2011), the Cochrane Central Register of Controlled Trials2011, issue 4 (The Cochrane Library); MEDLINE (Ovid) (1948 to November Week 3 2011); EMBASE (Ovid) (1974 to 2011 Week47); ISI Web of Science: Science Citation Index Expanded (1970 to 1 December 2011); ISI Web of Science: Conference ProceedingsCitation Index-Science (1990 to 1 December 2011); CINAHL (EBSCO) (1982 to 1 December 2011); National Research Register(2007, Issue 1) and PubMed (searched 1 December 2011). Bibliographies of trials retrieved were searched, and for the initial versionof the review drug companies manufacturing colloids were contacted for information (1999).Selection criteria
Randomised controlled trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement.Data collection and analysis
Two review authors independently extracted the data and assessed the quality of the trials. The outcomes sought were death, amountof whole blood transfused, and incidence of adverse reactions.Main results
Eighty-six trials, with a total of 5,484 participants, met the inclusion criteria. Quality of allocation concealment was judged to beadequate in 33 trials and poor or uncertain in the rest.
Deaths were reported in 57 trials. For albumin or plasma protein fraction (PPF) versus hydroxyethyl starch (HES) 31 trials (n = 1719)reported mortality. The pooled relative risk (RR) was 1.06 (95% confidence interval (CI) 0.86 to 1.31). When the trials by Boldt wereremoved from the analysis the pooled RR was 0.90 (95% CI 0.68 to 1.20). For albumin or PPF versus gelatin, nine trials (n = 824)
Colloid solutions for fluid resuscitation (Review)Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
reported mortality. The RR was 0.89 (95% CI 0.65 to 1.21). Removing the study by Boldt from the analysis did not change the RRor CIs. For albumin or PPF versus dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). Forgelatin versus HES 22 trials (n = 1612) reported mortality and the RR was 1.02 (95% CI 0.84 to 1.26). When the trials by Boldt wereremoved from the analysis the pooled RR was 1.03 (95% CI 0.84 to 1.27). RR was not estimable in the gelatin versus dextran andHES versus dextran groups.
Forty-one trials recorded the amount of blood transfused; however, quantitative analysis was not possible due to skewness and variablereporting. Twenty-four trials recorded adverse reactions, with two studies reporting possible adverse reactions to gel and one to HES.Authors’ conclusions
From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the CIs were wideand do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significantdifferences in mortality are to be detected or excluded.P L A I N L A N G U A G E S U M M A R YAre particular types of colloid solution safer for replacing blood fluids than others?
When a person is bleeding heavily, the loss of fluid volume in their veins can lead to shock, so they need fluid resuscitation. Colloidsand crystalloids are two types of solutions used to replace lost blood fluid (plasma). They include blood and synthetic products. Bothcolloids and crystalloids appear to be similarly effective at resuscitation. There are different types of colloids and these may have differenteffects. However, the review of trials found there is not enough evidence to be sure that any particular colloid is safer than any other.Colloid solutions for fluid resuscitation (Review)Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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